Lonely, alone, isolated or loving, meaningful and connected

As Sue Bourne from the Guardian suggests (04.01.16) the problem is that we’re all a bit scared of loneliness. Of being alone, of being isolated, of not being loved or needed or cared about.“Lonely” hits a spot of fear in all of us.

So what does it mean to be lonely? Definitions include feeling remote or having no friends or company. However, even those who have friends can feel lonely.When we feel lonely we miss the deeper connections of companionship.

We need companionship to affirm our value as a person and to support us with our feelings, actions, challenges and decision making.

So why is loneliness such a concern? It’s because there are increased health risks associated with loneliness and these are more apparent in older people. Loneliness and/or social isolation can come about by changes in circumstances including retirement, decreased mobility, low income, increased illness and disability as well as the loss of a spouse or companions within our social networks. These health risks affect our physical as well as our mental health. The distinction between loneliness and social isolation is expressed as loneliness is feeling alone and is a subjective, distressing feeling whereas social isolation is associated with being alone and an objective lack of relationships (Cornwell and Waite, 2009). These concepts are distinct from each other as you can be alone without being lonely.

People living with dementia are also at risk of loneliness in fact, people living with dementia tend to be lonelier than the population as a whole and a survey by the Alzheimer’s Society in 2013 found 62% of people living with dementia who live alone feel lonely and 38% of all people with dementia felt lonely. The nature of dementia can make loneliness worse, rather than loneliness causing dementia, although evidence that the risk of Alzheimer’s disease more than doubles in older people experiencing loneliness (Wilson et al., 2007).

There are also social factors such as stress, negative life events and poor social support which can influence how we think about loneliness and the ability to cope with changing circumstances. Loneliness is an individual perception based on the quality of social relationships. A key point to raise is the word perception as individuals can live solitary lives and not feel lonely yet individuals who have social relationships can still experience feelings of loneliness. Companions, partners, friends and family don’t always allow us to share our feelings or make us feel valued. Loneliness can be a vicious cycle; we feel isolated so we don’t talk to people and we don’t talk to people which makes us more isolated.

Evidence suggests that older people who experience changes within their social circumstances and manage to stay connected socially, experience much less physical or mental health problems than those that become lonely and isolated (Cornwell and Waite, 2009). For older people who struggle to cope with changes in their social circumstances, there needs to be a way of recognising this to help them to feel supported, less isolated and valued.

A ground breaking study undertaken by Harvard University over 75 years followed 268 undergraduate men and tracked a range of factors in the men's lives, including intelligence levels, alcohol intake, relationships and income. Harvard psychiatrist George Vaillant, who led the study from 1972 to 2004, published a book of the findings. The book is unique as it includes an amalgamation of statistics and anecdotes about the human experience. His findings suggest that we should value love above all else. There are two pillars of happiness according to Vaillant (2015) one is love, the other is finding a way of coping with life that does not push love away. The message appears to be that we should not underestimate the power of love, because it is the key to happiness.

Age UK (2016) have recently published a report ‘No one should have no one’. It builds on their initiatives such as ‘Call in Time’ and ‘The Campaign to End Loneliness’ as well as local Age UK initiatives. They developed a framework for loneliness which has four main themes focused on services to reduce the numbers of older people experiencing, or at risk of, loneliness. These services are foundation services to reach and understand the specific needs of those experiencing loneliness; direct interventions which are menu of services that directly improve the number or quality of relationships older people have; gateway services which aim to improve transport and technology provision to help keep older people connected and independent and finally, structural enablers which aim to create the right structures and conditions in a local community.

From a professional perspective; in order for social isolation to be recognised, health and social care professionals could screen for loneliness through home visits, hospital discharge planning or annual health screening programmes in primary care clinics. This kind of screening could highlight people who are at risk of becoming lonely and socially isolated.

Research, policy and age friendly actions to address loneliness and social isolation are increasingly at the forefront of government policy and more needs to be done as the population ages especially in light of the fact social isolation is an everyday yet preventable problem affecting older people.